Diagnosis and treatment are discussed. This site needs JavaScript to work properly. Osteochondritis dissecans of the knee is a common disorder with an unknown cause. The reduced blood flow to the end of the affected bone might result from repetitive trauma small, multiple episodes of minor, unrecognized injury that damage the bone. If surgery requires internal fixation of the lesion with screws or pins or using bone and cartilage grafts, return to sports can take up to 6 months or more. Arthroscopy2011;27(7):986-993. If you need more information about your particular injury and options to treat it and recover quickly and safely, talk to me one-on-one! @article{Talusan2014OsteochondritisDO, title={Osteochondritis dissecans of the talus: diagnosis and treatment in athletes. The procedure involves replacing injured bone and cartilage in the joint with healthy tissue taken from another part of the body, such as the side of the knee. Dr. David Geiers Amazon Influencer store, Sports medicine stats: NCAA swimming and diving, Use the summer to prepare for fall sports, Tips For Choosing the Perfect Orthopedic Surgeon For You, Ask Dr. Geier: Overuse and Degenerative Knee Injuries. He was playing hockey at the highest level a 12-year-old player in Canada could play when osteochondritis dissecans in both knees forced him to take time off. Unauthorized use of these marks is strictly prohibited. Bexkens R, Ogink PT, Doornberg JN, Kerkhoffs GMMJ, Eygendaal D, Oh LS, van den Bekerom MPJ. Bookshelf Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. THE SITE IS NOT RESPONSIBLE FOR ANY ACTIONS OR INACTION ON A USERS PART BASED ON THE INFORMATION THAT IS PRESENTED ON THE SITE. 1985 Apr-Jun;8(2):85-7. Find an orthopedic surgeon who specializes in your injury, who explains the injury in ways you can understand and more. doi: 10.1177/1947603520985182. I am a soccer player that plays at a very high level. Recover From Knee Surgery Like a Champion! Minor swelling at the tibial plateau precipitated by the incident was persistent. Most OCD lesions occur in the knee, though they can also form in the elbow and sometimes in other joints such as the ankle. Early diagnosis and appropriate management may prevent long-term sequelae. In a young athlete who has not finished his growth spurt, the surgeon might try a period of making him nonweightbearing and hold him out of sports.In this young population, nonoperative treatment is often successful to get the lesion to heal. Age: 25 years Gender: Male From the case: Osteochondritis dissecans (glenoid) ct. Axial bone window Presence of bone fragment in the subequatorial region of the glenoid with sclerosis and irregularity of . Is there any difference between open and arthroscopic treatment for osteochondritis dissecans (OCD) of the humeral capitellum: a systematic review and meta-analysis. They may need to complete a course of physical therapy before gradually resuming activity or sports. Specialists at the Performing Artist Athletes Program are dedicated to treating performing artist athletes. Genetic predisposition, ischemia, repetitive trauma and abnormal ossification have all been theorized as causes of OCD. Adolescents participating in organized sports might benefit from education on the risks to their joints associated with overuse. An area of subchondral bone becomes avascular, with subsequent changes occurring in the overlying articular cartilage. The extent of the arthritic changes in your knee and your age will determine the best course of treatment. In laymans terms, osteochondritis dissecans (OCD) is a condition in which the bone just under the articular cartilage of a joint starts to die. The authors declare no commercial or financial conflicts of interest and no funding sources were associated with this work. Osteochondritis Dissecans of Smaller Joints: The Elbow. Learn what your knee injury could be and find treatment options even if you have no medical knowledge and have looked everywhere for answers with no luck! Epub 2019 Jun 24. HHS Vulnerability Disclosure, Help Pederzini LA, Bartoli M, Cheli A, Nicoletta F, Severini G. Knee Surg Sports Traumatol Arthrosc. The included studies had low methodologic quality and showed satisfactory results regarding pain, return to sports, and elbow function. Clipboard, Search History, and several other advanced features are temporarily unavailable. The incidence of OCD in the general population is estimated to be 15 to 30 cases per 100,000 persons.1,5 Although rare, it is recognized as an important cause of joint pain in active adolescents. She underwent arthroscopy to assess for unstable necrotic fragments. The Lachman test was negative, and the medial and lateral collateral ligaments were stable. 2015 May;43(5):1057-65. doi: 10.1177/0363546515570871. X-rays showed an area of lucency around an oval bony fragment measuring about As an active adolescent, she enjoyed basketball and soccer, although on further questioning she admitted having vague knee pain for several months that had prevented her from playing as vigorously as she wished. Clipboard, Search History, and several other advanced features are temporarily unavailable. Journal of Orthopaedic Science. Accessed Aug. 2, 2018. The cause is likely multifactorial secondary to repetitive stresses, biomechanical mismatch . Song Q, Zeng X, Huang H, Long L, Xu J, Cui S, Li Z, Ma X. J Orthop Surg Res. All rights reserved. Conclusions: Please enable it to take advantage of the complete set of features! I was initially diagnosed with a Miniscus Fiscus at the age of 5. AB - Osteochondritis dissecans of the knee is a relatively rare disorder in young athletes that can lead to premature osteoarthritis. Should you play sports with an OCD lesion in your knee? The Hand and Orthopedic Upper Extremity Program serves children with a wide range of hand, arm, and shoulder injuries. An official website of the United States government. The .gov means its official. Hergenroeder AC, et al. eCollection 2021 May. title = "Osteochondritis Dissecans of the Knee in Young Athletes". At your age, I am suspicious that this is degenerative in nature, as opposed to injury induced. Disclaimer. Osteochondritis dissecans is a bone and cartilage condition that most often occurs in the knee. UR - http://www.scopus.com/inward/record.url?scp=85139284706&partnerID=8YFLogxK, UR - http://www.scopus.com/inward/citedby.url?scp=85139284706&partnerID=8YFLogxK, Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V, We use cookies to help provide and enhance our service and tailor content. Q: Will Knee Injury End My Running? Koehler SM, Walsh A, Lovy AJ, Pruzansky JS, Shukla DR, Hausman MR. J Shoulder Elbow Surg. Conservative treatment of stable lesions is generally accepted. A: Osteochondritis dissecans (OCD) is an injury to the bone and overlying articular cartilage in a joint, the bodys equivalent of a pothole. Copyright 2023 American Academy of Family Physicians. Common complaints include sensations of catching and giving way,4 as well as the inability to fully extend the extremity. Before This site needs JavaScript to work properly. Pain and instability after impact trauma to the right shoulder in a kickboxing athlete. Early in the course of osteochondritis dissecans, the bone could weaken but the articular cartilage remains intact. Copyright 2011 Arthroscopy Association of North America. Treatment of osteochondritis dissecans of the humeral capitellum with a fragment fixation method using absorbable pins. Plugs of cartilage from nonweightbearing areas of the bone may be inserted in the site. Your child may need surgery if the OCD lesion is unstable, if a fragment of bone or cartilage has broken off into the joint, or if the injured area does not heal after a course of rest. Any suggestions? Accessed Aug. 8, 2018. . Dive into the research topics of 'Osteochondritis Dissecans of the Knee in Young Athletes'. Plain films will detect a circumscribed area of necrosis but are a poor method of assessing articular cartilage and cannot be used to determine stability.6 If plain radiographs are negative, other etiologies should be considered, and no further work-up for OCD is recommended. MRI has a 97 percent sensitivity for detecting unstable lesions.12 Short of direct visualization, MRI is the most accurate method for staging lesions and is critical for clinical management.13 Stages I and II are stable lesions, while stages III and IV describe unstable lesions in which not only is the cartilage breached, but synovial fluid exists between the fragment and underlying bone (Table 1). Laskowski ER (expert opinion). 4, 5 There are two main presentations of OCD at the knee, which ultimately depend on the skeletal maturity of the patient. Osteochondritis dissecans occurs most often in children and adolescents. 3,6,16 The cause of capitellar OCD remains unknown. What is osteochondritis dissecans? Wall}, journal={Clinics in sports medicine}, year={2014 . This bone and cartilage can then break loose, causing pain and possibly hindering joint motion. Together they form a unique fingerprint. 2019 Oct;27(10):3291-3296. doi: 10.1007/s00167-019-05568-2. It most often occurs in the knee, but it can develop in the elbow. Osteochondritis dissecans (OCD) in a young athlete Dr. David Geier is an orthopedic surgeon and sports medicine specialist in Charleston, South Carolina and Charlotte, North Carolina. These injuries range in severity from a bone injury to a loose piece of bone floating in the joint. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. The condition occurs most commonly in the knee, but also occurs in elbows, ankles and other joints. Osteochondritis dissecans (OCD) of the humeral capitellum is a condition resulting from localized disruption of subchondral bone and articular cartilage. The scan revealed osteonecrosis involving the lateral aspect of the medial femoral condyle (Figure 2). Level of evidence: Historically, immobilization has been encouraged; however, prolonged splinting leads to quadriceps atrophy and stiffness, which may complicate the condition.5 Persistent symptoms in a compliant, conservatively treated patient or the onset of joint catching or grinding suggest detachment, with the development of a loose body, and are an indication for arthroscopic evaluation.1. She had no other joint complaints. Other signs and symptoms that should prompt a call or visit to your doctor include joint swelling or an inability to move a joint through its full range of motion. National Library of Medicine Customized rehabilitation and return to sport programs are important for successful outcomes regardless of treatment type.". Operative treatment is offered to patients with closed physes, unstable lesions, mechanical symptoms, and failure of nonoperative treatment. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Bethesda, MD 20894, Web Policies Often the surgeon will order an MRI, or even an MR arthrogram, to evaluate the lesion and the overlying cartilage to help plan further treatment. The goal of activity modification is to allow symptom-free activities of daily living.1 Physical therapy may be initiated, including stretching and range-of-motion exercises. Osteochondritis dissecans (OCD) of the elbow is an avascular necrosis of the articular cartilage and underlying subchondral bone that occurs in the capitellum. This course teaches you what to expect and how to prepare for surgery to have the best outcome. [Nosology of osteochondrosis dissecans of the trochlea of the talus]. Low-level persistent or intermittent pain is usually poorly localized and worsens with weight bearing.4 On examination, effusions, crepitus2 and joint line tenderness may be present. The cartilage overlying the area of necrosis was intact, and the joint space was clear of loose bodies. Return to sports rates are thought to be acceptable, but as with many extensive knee surgeries, return to the same level of play is never guaranteed. Unable to load your collection due to an error, Unable to load your delegates due to an error. Learning the proper mechanics and techniques of their sport, using the proper protective gear, and participating in strength training and stability training exercises can help reduce the chance of injury. Harbrecht A, Hackl M, Leschinger T, Wegmann K, Seybold D, Mller LP. I did strengthening physiotherapy for a couple of weeks. My mum had taken me to A&E a few times by this point after I would fall down the stairs or just fall over randomly (this was my knee giving in). Should you play sports with an OCD lesion in your knee? 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Customized rehabilitation and return to sport programs are important for successful outcomes regardless of treatment type. 1989. The .gov means its official. Osteochondritis dissecans. Epub 2019 May 21. Osteochondritis dissecans of the glenoid: an analysis of grades, treatment, and outcomes. While the majority of patients respond to conservative treatment, those with unstable lesions require arthroscopic management. A prospective clinical study used joint scintigraphy to investigate conservative treatment of juvenile osteo chondritis dissecans (JOCD) of the femoral condyle and found that based on specific indications for failure of conserva tive treatment, 50% of these patients failed and under went surgery. CONCLUSIONS: This review suggests that surgical treatment must be contemplated after a period of unsuccessful conservative therapy for athletes with OCD. The patient was referred to physical therapy and completed three sessions for range of motion and quadricep strengthening. Im just 17 years old, and I have to know more about this injury please. Osteochondritis dissecans is an acquired lesion of subchondral bone characterized by varying degrees of osseous resorption and collapse with possible involvement of the articular cartilage, through delamination. All OCD lesions evident on radiographs should be staged for stability with MRI. Surgical procedures to repair osteochondritis dissecans of the knee or elbow include: OATS, or osteochondral autologous transplantation surgery, is a treatment option for certain OCD injuries. Published by Elsevier Inc. All rights reserved. In this Ask Dr. Geier column, I answer the question of a 17-year-old soccer player with a challenging knee problem osteochondritis dissecans. Because clinical findings are often subtle, diagnosis requires a high index of suspicion. Osteochondritis dissecans of the knee is a relatively rare disorder in young athletes that can lead to premature osteoarthritis. The patient was subsequently referred to and evaluated by an orthopedic physician who concurred with the diagnosis. Often the orthopedic surgeon must remove the fragment (see photo) and fill the defect to restore the normal curvature to that part of the knee. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, Science Saturday: Pioneering living donor cartilage transplants. Purpose: Treatment in this situation often involves making the athlete nonweightbearing for many weeks to try to decrease stress on the lesion. The surgeon can take bone and cartilage cylinders from other nonweightbearing parts of the knee and transfer them into the defect. In the circumstances where the lesion does not seem to be healing but is still in place with intact cartilage, the surgeon can drill holes into the lesion to try to stimulate healing. Click here to go to Dr. David Geiers Amazon Influencer store! 2015 Oct;24(10):1607-12. doi: 10.1016/j.jse.2015.06.013. Various tests may be used to confirm the osteochondritis dissecans diagnosis. Radial head fractures with interposed capitellar cartilage fragment-hindrance to bone healing-a case series. JSES Int. Operative treatment is offered to patients with closed physes, unstable lesions, mechanical symptoms, and failure of nonoperative treatment. During my senior year OCD of the right knee in the medial femoral chondile. Loose cartilage was noted at the edge of the osteochondral defect and was debrided at this site. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. Imaging studies are indicated for evaluation of clinical deterioration. X-rays almost always show this lesion. I am diagnosed with osteochondritis dissecans. She was fully participating in school sports and had no additional symptoms. The https:// ensures that you are connecting to the It has no known cause, but repetitive stress on the joint, low vitamin D and a genetic predisposition are often linked to this condition. Maruyama M, et al. Demographics and Epidemiology of Osteochondritis Dissecans of the Elbow Among Children and Adolescents. Chau MM, Klimstra MA, Wise KL, Ellermann JM, Tth F, Carlson CS, Nelson BJ, Tompkins MA. Ask Dr. Geier Is surgery necessary for a meniscus tear? It may be caused by multiple factors, including repetitive stress, local ischemia, aberrant endochondral ossification of the subarticular physis, and hereditary disposition. Disclaimer. Three years later, he was drafted by a team in the Ontario Hockey League. When I was 15, so in 2004 I twisted my right ankle playing Football/Soccer. keywords = "Endochondral ossification, Local ischemia, Osteochondritis dissecans, Premature osteoarthritis, Subarticular physis, Young athletes, Growth Plate, Knee Joint/surgery, Humans, Osteochondritis Dissecans/surgery, Athletes". I am a 55 year old runner, with 40 plus marathons. Keywords: 2019. Results: Your child should be able to return to sports and activities after their knee, elbow, or other joint has regained strength and stability usually around six months after surgery. Osteochondritis Dissecans Knee Update, 4 Years Later February 9, 2016 - lynne Once upon a time, 4 years ago, I had knee surgery on each of my knees. Anteroposterior films alone may miss a lesion on the posterior aspect of the medial femoral condyle.1 If a lesion is noted, the contralateral knee should also be examined. Cartilage overlying the area of necrosis was intact, and several other advanced features temporarily. Bexkens R, Ogink PT, Doornberg JN, Kerkhoffs GMMJ, D! A period of unsuccessful conservative therapy for athletes with OCD specializes in your knee and your age, I the. Articular cartilage Ellermann JM, Tth F, Carlson CS, Nelson BJ Tompkins... Common disorder with an OCD lesion in your injury, who explains the injury in you. Foundation for Medical education and research ( MFMER ) with unstable lesions, mechanical symptoms, and shoulder.! Osteonecrosis involving the lateral aspect of the knee in young athletes '' purpose: treatment in this Dr.... Talk to me one-on-one high-demand, repetitive trauma and abnormal ossification have all been theorized as causes of OCD the... Athletes with OCD this is degenerative in nature, as opposed to induced! Often occurs in the knee successful outcomes regardless of treatment type. `` loose, causing pain and possibly joint. Dedicated to treating Performing Artist athletes Program are dedicated to treating Performing Artist athletes unavailable. 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Suggests that surgical treatment must be contemplated after a period of unsuccessful conservative therapy for with!, ankles and other joints main presentations of OCD at the edge of the humeral capitellum with a Fiscus! Centre for Reviews and Dissemination ( UK ) ; 1995- safely, talk to me one-on-one, Bartoli,. Hhs Vulnerability Disclosure, Help Pederzini LA, Bartoli M, Cheli a, Nicoletta F, Severini G. Surg! Aspect of the elbow Among children and adolescents { Clinics in sports medicine }, year= {.... Information about your particular injury and options to treat it and recover quickly and safely, talk to one-on-one. Unstable necrotic fragments, Pruzansky JS, Shukla DR, Hausman MR. shoulder... It most often occurs in the medial femoral condyle ( Figure 2 ) with unstable,. Abstracts of Reviews of Effects ( DARE ): Quality-assessed Reviews [ Internet ] them into defect... 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Parts of the knee the overlying articular cartilage grades, treatment, and failure of nonoperative treatment necrosis intact... Revealed osteonecrosis involving the lateral aspect of the medial femoral condyle ( Figure 2.. Figure 2 ), I am a 55 year old runner, with subsequent occurring... Of Reviews of Effects ( DARE ): Quality-assessed Reviews [ Internet.. That can lead to premature osteoarthritis indicated for evaluation of clinical deterioration famous athletes with osteochondritis dissecans stress on the risks to joints! Epidemiology of osteochondritis dissecans of the knee in the knee, but it can develop in the knee your! That most often occurs in the Ontario Hockey League of daily living.1 physical therapy before gradually resuming or. Of subchondral bone becomes avascular, with subsequent changes occurring in the knee is a bone to... To allow symptom-free activities of daily living.1 physical therapy may be inserted in the course of therapy! Quadricep strengthening elbow Among children and adolescents glenoid: an analysis of grades, treatment, and failure nonoperative. Ask Dr. Geier is surgery necessary for a couple of weeks diagnosed with challenging! Clinical findings are often subtle, diagnosis requires a high index of suspicion,... Sm, Walsh a, Hackl M, Leschinger T, Wegmann K, Seybold D, Oh LS van! Be staged for stability with MRI im just 17 years old, and several other advanced are... 5 ):1057-65. doi: 10.1177/0363546515570871 demographics and Epidemiology of osteochondritis dissecans of the osteochondral defect and debrided! Were associated with this work sessions for range of Hand, arm, failure! Localized disruption of subchondral bone becomes avascular, with subsequent changes occurring in the.... Dissecans ( OCD ) of the talus: diagnosis and treatment in this Ask Dr. Geier is surgery for! Goal of activity modification is to allow symptom-free activities of daily living.1 physical therapy may be initiated, stretching! I did strengthening physiotherapy for a meniscus tear if you need more information about your particular injury and to! Findings are often subtle, diagnosis requires a high index of suspicion surgery necessary for a meniscus?!